Hemorrhoids, also known as piles, are the dilatation, the stretching beyond normal dimensions of radicles of rectal veins inside the anal canal. In this instance a radicle is the smallest branch of a blood vein. Veins are weak compared to arteries due to their thin walls, therefore veins can become strained and twisted with any great back pressure. Veins have one-way valves to prevent back flow. The three rectal veins are named accordingly superior, middle and inferior rectal veins. Obstructions or pressure increase in these veins cause hemorrhoids.
Piles, or hemorrhoids, come in two types, internal and external. External hemorrhoids are outside the anus and are skin covered. Their color may be brown or black. Because nerves are so abundant in the anal area an external hemorrhoid is extremely painful.
The second type, internal hemorrhoids are in the interior of the anal canal, internal to the anus. They are purple or red and have a mucous membrane covering. They are usually painless. It isn’t unusual for a person to have both external and internal hemorrhoids at the same time.
Conditions that can lead hemorrhoids –
Hemorrhoids, a familial disease, tend to occur among members of a family, is sometimes blamed on heredity. The only animals that get hemorrhoids are those that stand on two legs. Most likely this is due to rectal vein congestion because of the pull of gravity. People who are chronically constipated often have piles problems. Resisting the urge to move your bowels at your body’s signal can bring about constipation and then hemorrhoids.
A high intake of meat, chicken, shrimp, spicy foods and more lead to hemorrhoids. The people least likely to get piles are those who have a high percentage of vegetables and fibrous food in their diet. Some women get hemorrhoids during pregnancy because of the uterus compressing the rectal veins. Rectal cancerous lesions might bring about hemorrhoids through obstructing blood flow.
Symptoms and indications of hemorrhoids –
With external hemorrhoids a protuberance can be seen and felt around the anus. There will be pain and discomfort in the anal area. While straining to expel a stool the pain will be worse.
Early on, internal hemorrhoids can’t be felt. Subsequently, in progression of the disease, the hemorrhoids will protrude as a stool is expelled and then retreat by themselves. When the condition worsens the protruded hemorrhoids won’t go back.
Bleeding isn’t unusual for either type hemorrhoid. However, when an internal hemorrhoid is retracted it could bleed internally, into the rectum. Bleeding occurs in splashes while pushing to expel a stool. In some cases the bleeding may be quite profuse. With both types of hemorrhoids there may be a mucus discharge and it will itch around the anus.
Other things brought about through hemorrhoids –
Hemorrhoids can become infected and the infection spreading to deeper veins and producing septicemia. Septicemia is blood poisoning caused by pathogenic microorganisms and their toxic products in the bloodstream.
Thrombosed hemorrhoids are not considered dangerous, however, they do cause considerable pain and swelling because they affect the nerve endings located in the anal skin. They’re first noticed as an acute extremely painful swelling at the anus. Thrombosis is the formation of a blood clot inside a blood vessel that obstructs the flow of blood. It occurs because of high pressure on the veins during excessive straining efforts. It’s rare to see thrombosis of an internal hemorrhoid.
Fibrosis usually follows thrombosis and is more common with external hemorrhoids than the internal type. Initially fibrosis is like a bump but with repeated friction of stool expulsion it will develop a stem like connecting part.
Suppuration is very rare and comes about because of infection of a thrombosed hemorrhoid. It’s accompanied by throbbing pain and swelling at the perianal region. An abscess with discharge of pus isn’t unusual.
Gangrene can develop when the tissues in the hemorrhoids and the adjoining skin die because of loss of blood supply. That occurs only when the arterial supply of the hemorrhoid is somehow or the other constricted.
Treatment of hemorrhoids –
Hemorrhoids are usually first treated based on the symptoms observed. Mild cases can be treated with over the counter medications, usually some type of cream or ointment. Moderately severe cases will respond to prescribed medications containing hydrocortisone acetate and pramoxine hydrochloride. Constipation should, of course be treated. If the medicines such as creams, ointments and foams are not producing results then the following treatments might be considered.
A thrombosed external hemorrhoid, one that has developed a blood clot, can be removed by cutting after administering local anaesthesia. The area is cut into using a scalpel and the clot is removed. There is nearly instant relief of the sharp pain. However, a dull ache may continue. Sitz baths, over-the-counter pain medications and the use of a rubber or air rubber donut may help with the pain.
Sclerosant injection can reduce hemorrhoid size. Sclerotherapy is a procedure used to treat blood vessels or blood vessel malformations. A medicine is injected into the vessels, which makes them shrink. This procedure is also used to treat varicose veins.
Rubber band ligation around the base of hemorrhoids is an useful outpatient treatment for second-degree internal hemorrhoids. The surgeon places a couple of tight rubber bands around the base of the hemorrhoidal vein which will cause it to lose its blood supply. The hemorrhoid will then shrivel and die within 2 to 7 days. The shriveled hemorrhoid and band will fall off during normal bowel movements.There may be some discomfort for a couple of days days after the procedure and a minor amount of bleeding may be experienced.
Cryosurgery has fallen out of favor as a treatment for hemorrhoids. The procedure consists of freezing and destroying internal or external hemorrhoids with a cryoprobe, which uses nitrous oxide or liquid nitrogen as freezing agents. The hemorrhoids are either directly frozen ligated first. In either case, local anaesthesia is usually used to deaden the pain.
Cryosurgery is more painful than other medical surgeries. And in addition, the patient will have an open wound for as long as a couple of weeks after surgery which can become infected. Moreover, patients can have an abnormal rectal discharge or foul odor which may require the use of absorbent pads.
Anal dilatation, or stretching of the anal canal, is no longer a method of choice for hemorrhoid treatment. The high incidence of fecal incontinence is, perhaps, the most objectionable side effect. Additionally, anal stretching can increase the rate of flatus incontinence. However, it may still be considered to help help younger women and en with overly tight sphincters who otherwise would have needed surgery. It may also helpful with strangulated and thrombosed prolapsed hemorrhoids.
Hemorrhoidectomy is the removal of hemorrhoids through surgery. It is done under general anesthesia and usually in a out patient surgery center. The surgery is performed with a scalpel, a tool that uses electricity (cautery pencil), or a laser. Hemorrhoidectomy is used primary only in severe cases for both internal and external hemorrhoids. It is significant post operative pain and usually it requires two to four weeks for recovery.
Prevention of hemorrhoids –
Diet and habits are the primary means of preventing hemorrhoids. Your diet should include plenty of of fruits and vegetables and fibrous food. Go easy on meats and shellfish. Eat when hungry, of course, but try to keep regular eating times. Make water your prime liquid intake, and drink plenty of it. Be regular in your bowel movements and do take something, food or medicine to treat constipation.